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Assisted Living Waiver

The Assisted Living Waiver (ALW) is a Home and Community-Based Services (HCBS) waiver that was created by legislation that directed the California Department of Health Care Services (DHCS) to develop and implement the project to test the efficacy of assisted living as a Medi-Cal benefit.

The pilot program was determined to be successful during the first three years in a limited trial in three counties.  In March 2009, the Centers for Medicare and Medicaid Services approved a waiver renewal for an additional five years and expansion of the program into additional counties.  Today the ALW is operating in Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Mateo, Santa Clara, and Sonoma counties.  A five year waiver renewal was effective March 1, 2014.

The goal of the ALW is to: 1) facilitate a safe and timely transition of Medi-Cal eligible seniors and persons with disabilities from a nursing facility to a community home-like setting in a Residential Care Facility (RCF), an Adult Residential Care Facility (ARF), or public subsidized housing, utilizing ALW services; and 2) offer eligible seniors and persons with disabilities, who reside in the community, but are at risk of being institutionalized, the option of utilizing ALW services to develop a program that will safely meet his/her care needs while continuing to reside in a RCF, ARF, or public subsidized housing.

ALW Participant Information


ALW eligible individuals are those who are enrolled in Medi-Cal and meet the level of care provided in a  nursing facility due to their medical needs.  Individuals with Medi-Cal benefits that include a share of cost may not enroll in the ALW.  The state does not determine eligibility for Medi-Cal benefits. 
Please contact your local county office to obtain information about how to apply for Medi-Cal benefits. 


Determination of care needs is done by registered nurses employed by a Care Coordination Agency (CCA).  Click on the Care Coordination Agencies link and contact one of the CCAs in your county of residence to request an assessment.  A pre-screening "assessment" will be done over the phone before an appointment is set up for the actual assessment.

Program Services

Participants in the ALW program will have access to three waiver benefits:

Assisted Living Services -These services are called the Assisted Living Services when they're provided in an Residential Care Facility or an Adult Residential Care Facility.  The services are called Assisted Care when they are provided by a licensed Home Health Agency and delivered to residents of publicly-funded housing.

  •  ALW Services 


Care Coordination - These services include identifying, organizing, coordinating, and monitoring services needed by a participant.  Care Coordinators conduct assessments to assist in determining eligibility, develop individualized Service Plans (ISPs), arrange for services, maintain contact with participants, and monitor service delivery on a monthly basis.


Nursing Facility Transition Care Coordination - This benefit helps to transition residents from nursing facilities to the community.

Additional Resources:

Provider Enrollment Information 

Last modified on: 9/29/2016 2:50 PM